# Successful Treatment of Median Nerve Mononeuropathy Occurring After Brachial Arterial Line Placement for a Prolonged Prone Spine Surgery With Ultrasound-Guided Peripheral Nerve Stimulation: A Case Report

## TL;DR

A patient with long-term nerve damage from a brachial artery line during surgery showed significant improvement using ultrasound-guided nerve stimulation.

## Contribution

Demonstrates the effectiveness of ultrasound-guided peripheral nerve stimulation for treating chronic median nerve injury after arterial cannulation.

## Key findings

- The patient experienced over 50% pain reduction and improved dexterity after PNS treatment.
- Ultrasound-guided PNS provided continued benefit alongside medication and therapy.
- The case supports PNS as a feasible option when conservative treatments fail for iatrogenic nerve injury.

## Abstract

Median nerve injury after brachial arterial access is uncommon but clinically meaningful, typically related to direct needle trauma, hematoma, pseudoaneurysm, or ischemia from arterial compromise. We report a case of a 66-year-old man with persistent neuropathic pain and sensory loss in the thumb to middle fingers, with symptom onset after a 12-hour prone spine surgery during which a brachial arterial line was placed. Symptoms persisted for more than one year despite conservative therapy. Electrodiagnostic testing demonstrated a chronic focal mononeuropathy of the median nerve with superimposed sensory polyneuropathy. Under ultrasound guidance, a percutaneous 60-day peripheral nerve stimulation (PNS) lead (SPRINT®, SPR Therapeutics, Cleveland, OH) was placed adjacent to the proximal median nerve. At two-month follow-up, the patient reported greater than 50% pain reduction, improved dexterity, and increased participation in therapy, with continued benefit on neuropathic medication and topical analgesic. This case highlights a delayed presentation of median neuropathy likely related to prior brachial arterial cannulation and supports ultrasound-guided PNS as a feasible, minimally invasive option when conservative measures fail. Recognition of this iatrogenic mechanism is important because timely evaluation and targeted neuromodulation can improve function and quality of life.